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Differences Between TRICARE and MEDICARE


TRICARE and Medicare have a tricky and complex relationship with one another. TRICARE, originally called CHAMPUS, for Civilian Health and Medical Care Program of the United States, is offered to those with links to the military, while Medicare is generally open to the public. To get into the differences between each of these programs, we'll begin by simply describing each of them.

TRICARE

The aim of TRICARE is to provide those with links to the military with civilian health care. Interestingly, TRICARE doesn't apply only to service members, but also to veterans, to the families of veterans and in some cases to civilian employees of the military. In essence, the program is there to ensure that people within the military and with ties to the military have more options when it comes to health care.

TRICARE has gone through a number of changes since its foundation as CHAMPUS and beyond, so it can get a little confusing. The program can be broken down as follows:

  • TRICARE Standard is available to active duty personnel, retirees, and eligible family of retirees. There is no enrollment fee, but beneficiaries may wind up paying coinsurance, deductibles and additional fees on an annual basis.
  • TRICARE Extra is a level above TRICARE Standard and is available to Standard beneficiaries. Extra can be obtained through a civilian health care provider.
  • TRICARE Prime is an HMO, or health maintenance organization, available to active duty personnel, retirees and eligible family members. Prime beneficiaries will choose a primary physician and while there is no enrollment fee, beneficiaries will pay a small copayment per visit.

Medicare

Most TRICARE beneficiaries of retirement age will actually combine TRICARE with Medicare. TRICARE itself is not really a full health insurance package, but rather, an additional means of obtaining health care. Eligibility for Medicare does not, of course, require that the beneficiary has served in the military.
Eligible requirements for Medicare include:

  • Beneficiary is 65 years or older
  • Beneficiary is a United States citizen, or has been legal United States residents for five years or longer
  • Beneficiary or beneficiary's spouse has paid Medicare taxes for at least ten years
  • Beneficiary is under 65, disabled and has been receiving SSDI benefits or Railroad Retirement Board disability benefits for at least 24 months from date of retirement
  • Beneficiary gets continuing dialysis treatment for end stage renal disease
  • Beneficiary is in need of kidney transplant
  • Beneficiary is eligible for SSDI and has ASI or Lou Gehrig’s Disease

Medicare benefits are divided into four parts...

A. Hospital Insurance

Part A covers hospital stays, requiring co-payments of $141.50 a day after the first twenty days, which will be paid for in full by Medicare. After eighty days, total, Medicare cuts off payment for hospital stays.

B. Medical Insurance

Part B is essentially basic medical coverage. X-rays, lab tests, canes, wheelchairs, mobility scooters, etc... Part B covers all of the basic expenses that are to be expected.

C. Medicare Advantage Plans

Medicare Advantage Plans are there to help beneficiaries access their A, B and D benefits.

D. Prescription Drugs

For a beneficiary to qualify for prescription drugs under Medicare, they have to be covered by a standalone prescription drug insurance program like PDP.

The Difference

All of this may seem confusing, but it's not really quite so complex: TRICARE helps to make health coverage easier and more affordable for veterans, for active duty military personnel and for their eligible family members.

If you are eligible for TRICARE, there's really no reason not to take advantage. By having easier access to health insurance, by being given precedence for civilian healthcare, military retirees and other individuals are able to spend less and get more from their health insurance packages. TRICARE is just another benefit available to people with links to the military.

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